Association Between Serum Cortisol and Chronic Kidney Disease in Patients with Essential Hypertension

Abstract

Background/Aims: Serum cortisol level is elevated in patients with essential hypertension. We aimed at investigating the association of serum cortisol levels with parameters of renal function in essential hypertension. Methods: One hundred and seventy-eight patients with essential hypertension participated in the study. Fasting serum samples were collected at 8:00 am. Renal function was measured as estimated glomerular filtration rate (eGFR) calculated by the Chronic Kidney Disease Epidemiology Collaboration creatinine- cystatin C equation (eGFRcr-cys). Correlation analysis and stepwise regression analysis were used to detect the relationship between cortisol and eGFRcr-cys. The distributions of serum cortisol were split by the tertiles and subjects were stratified into those with low, median and high levels accordingly. Results: Serum cortisol levels were significantly higher in subjects whose eGFRcr-cys<90 ml/min/1.73 m² than subjects whose eGFRcr-cys>90 ml/min/1.73 m² (394.0±93.4 vs. 343.2±98.4 nmol/L, P=0.001). Age, systolic blood pressure, and serum total cholesterol, uric acid, cortisol levels were significantly associated with eGFRcr-cys, serum levels of creatinine and cystatin C. After adjusting for clinical factors, serum cortisol level had a statistically significant negative association with the eGFRcr-cys (β=-0.19, P=0.027), and positive associations with cystatin C (β=0.31, P=0.001) and creatinine (β=0.14, P=0.044). With the increment of cortisol tertile, the eGFRcr-cys significantly decreased (93.18±14.36 vs. 84.61±14.67 vs. 81.29±12.36 ml/min/1.73 m² for low, median and high tertile, respecively, P=0.001). Conclusion: Serum cortisol level was negatively correlated with eGFRcr-cys in subjects with essential hypertension. Further studies are needed to investigate whether cortisol plays a role in hypertensive nephropathy development.

The Association Of Serum Cortisol Level With Microalbuminuria In Patients With Type 2 Diabetes And Prediabetes

“…Effective weight loss by lifestyle intervention and bariatric surgery were both associated with decreased cortisol levels in obese individuals 20 , 24 . Among subjects with similar BMI values, no significant difference was found in cortisol levels between patients with MetS and those without MetS 9 . Also, varied cortisol secretion patterns might present in patients in different age or development phase.…”

“…A study in patients with essential hypertension demonstrated that serum cortisol level was negatively correlated with eGFR levels. But the researchers did not assess proteinuria 9 . In the present study, we found a significant positive correlation between serum cortisol and microalbuminuria, but not eGFR.…”

“…Besides the traditional cardiometabolic factors, cortisol secretion is also suggested to correlate with renal function in a few studies 9 , 10 . Serum cortisol level was negatively correlated with eGFR levels in patients with essential hypertension.…”

An integrative review of the methods used for cortisol assessment in clinical studies investigating the association between Blood Pressure and Cortisol Hormone

“…Renal function parameters such as creatinine and cystatin C (eGFRcr-cys) are related to the high level of cortisol in subjects with SAH. 6,24 Recent studies have shown that deregulation of the HPA axis together with chronic stress increases the likelihood of SAH, leading to heart disease such as ischemia, a deficit in blood perfusion and stroke-related diseases. 22,23 In another investigation, it was suggested that healthy individuals with a genetic history of SAH have a marked increase in catecholamines and cortisol for stressors in relation to elevated plasma levels when compared to those with no parental history.…”

Effect of monitored anesthesia care using dexmedetomidine on stress hormones and interleukin-6 in patients undergoing arteriovenous fistula formation

“…Patients with end-stage renal disease also showed increased levels of pro-inflammatory cytokines (such as IL-1, IL-6, and tumor necrosis factor [TNF]-α), cortisol, and glucose [16][17][18]. Particularly, cortisol levels in serum were significantly higher in patients with impaired glomerular filtration rate [19].…”